Touchless input ultrasound control

ABSTRACT

A method and apparatus are disclosed herein for controlling an ultrasound machine using one or more touchless inputs. In one embodiment, the method for controlling operation of the ultrasound machine comprises obtaining one or more touchless inputs; determining one or more operations to control the ultrasound machine based on the one or more touchless inputs and machine state of the ultrasound machine; and controlling the ultrasound machine using the one or more operations.

RELATED APPLICATION

The present application is a continuation of and claims the benefit ofU.S. patent application Ser. No. 17/103,599, filed on Nov. 24, 2020which is a continuation of and claims the benefit of U.S. Pat. No.10,863,971, issued on Dec. 15, 2020 and entitled “TOUCHLESS INPUTULTRASOUND CONTROL”, and which are incorporated by reference in theirentirety.

FIELD OF THE INVENTION

One or more exemplary embodiments relate to an ultrasound machine and amethod of operating the same, and more particularly, to an ultrasoundmachine that uses lip reading to generate, at least in part, operationsto control an ultrasound machine.

BACKGROUND OF THE INVENTION

Ultrasound systems radiate an ultrasonic signal generated from anultrasound probe into an object, such as a patient, and receive an echosignal reflected from the internal part of the object. An image of theinternal part of the object is generated using received echo signals.More specifically, ultrasound diagnostic machines generate an ultrasoundimage by using ultrasonic image data acquired from an ultrasound probeand display the generated ultrasound image on a screen to provide theultrasound image to a user. The ultrasound machine may include a controlpanel for controlling the ultrasound machine and setting variousfunctions.

In general, ultrasound machines have multiple functional keys forreceiving user input and an input device, such as a keyboard, that arepart of a control panel. In order for the user to control an ultrasoundsystem including an ultrasound probe, various input units on the controlpanel have to be manipulated by a user, which causes inconvenience whenusing the ultrasound system. In particular, when a clinician performs adiagnosis of a patient by using the ultrasound probe, it may beinconvenient for a user to manipulate the control panel that is spacedapart from the user and that takes a long time to manipulate.

Furthermore, clinicians often need to adjust the ultrasound machineduring sterile procedures. However, they cannot easily do so becausethey are working in a sterile field with an ultrasound machine that isnot sterile and touching it would break sterility. Also, both hands areoften engaged, one to hold the probe and one to hold an instrument suchas a needle for injection or biopsy, such that there is no spare hand toreach to the machine controls. The clinician often deals with this byhaving a nurse or assistant adjust the machine for them, but this isinefficient and not always possible. The clinician sometimes uses asterile device such as a cotton swab to adjust the ultrasound machine,but this is awkward and requires disposal of the swab with eachadjustment (as the dirty swab should not be returned to sterile field).

Some ultrasound machines use voice control of the ultrasound machine todeal with this issue. Generally, this does not work well because ahospital tends to be a very noisy space and it is difficult for thevoice control to pick out commands from the background noise or otherconversations. This is particularly important in a hospital settingbecause the user definitely does not want the ultrasound machine tochange state when not specifically commanded, especially at a criticaltime in the procedure.

Some ultrasound machines have buttons on the probe to control theultrasound machine. These can be awkward to use because of the differentgrip positions that are required with the buttons being present and thefact that the probe may be covered by a sterile sheath.

SUMMARY OF THE INVENTION

A method and an apparatus are disclosed herein for controlling anultrasound machine using one or more touchless inputs. In oneembodiment, the method for controlling operation of the ultrasoundmachine comprises obtaining one or more touchless inputs; determiningone or more operations to control the ultrasound machine based on theone or more touchless inputs and machine state of the ultrasoundmachine; and controlling the ultrasound machine using at least one ofthe one or more operations.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood more fully from the detaileddescription given below and from the accompanying drawings of variousembodiments of the invention, which, however, should not be taken tolimit the invention to the specific embodiments, but are for explanationand understanding only.

FIG. 1 is a flow diagram of one embodiment of a process for controllingan ultrasound machine using touchless inputs.

FIG. 2 is a flow diagram of one embodiment of a process for triggeringthe lip reading.

FIG. 3 is a block diagram of one embodiment of an ultrasound systemhaving a command generator.

FIG. 4 illustrates a block diagram of one embodiment of a recognizerhaving one or more recognition components to perform one or morerecognition routines.

FIG. 5 is a block diagram of an embodiment of an ultrasound systemhaving a command generator that comprises artificial intelligence ormachine learning.

FIG. 6 is a flow diagram of one embodiment of a process for controllingthe ultrasound machine using a neural network.

DETAILED DESCRIPTION

In the following description, numerous details are set forth to providea more thorough explanation of the present invention. It will beapparent, however, to one skilled in the art, that the present inventionmay be practiced without these specific details. In other instances,well-known structures and devices are shown in block diagram form,rather than in detail, in order to avoid obscuring the presentinvention.

Methods and apparatuses for generating commands to control an ultrasoundmachine using lip reading and machine state information of theultrasound machine are disclosed. The use of lip reading for controllingan ultrasound machine enables hands-free operation, which is veryadvantageous, particularly in sterile medical environments. In oneembodiment, the commands are determined using touchless commands. Thetouchless commands may be identified using video image and/or audio. Inone embodiment, the touchless commands comprise a combination of lipreading and additional information, such as, but not limited to, one ormore the examination type being performed with the ultrasound machine,features from an ultrasound image, expectations of what the user may donext with the ultrasound machine, etc. In one embodiment, the commandsare determined using a command generator that includes a neural network(e.g., a deep learning neural network) or other artificial intelligencefunctionality.

FIG. 1 is a flow diagram of one embodiment of a process for controllingan ultrasound machine using touchless inputs. The process is performedby processing logic that may comprise hardware (circuitry, dedicatedlogic, etc.), software (such as is run on a general-purpose computersystem or a dedicated machine), firmware, or a combination of the three.

Referring to FIG. 1 , the process begins by performing lip reading,which includes capturing lip movements with one or more cameras andperforming lip recognition on those lip movements (processing block101). There are a number of techniques to perform lip reading bycapturing images of lips, analyzing the images (e.g., measure the heightand width of the lips from images captured by a camera as well as otherfeatures such as the shape of the ellipse bounding the lips, etc.) todetermine the movement of the lips, recognizes a sequence of shapesformed by the mouth and then matching them to a specific word orsequence of words. In one embodiment, the lip reading is performed usinga neural network (e.g., a deep learning neural network).

Next, processing logic determines operations to control an ultrasoundmachine based on one or more touchless inputs and machine stateinformation of the ultrasound machine (processing block 102). In oneembodiment, the operations are determined using a command generator ofan ultrasound machine. In one embodiment, the command generator isimplemented with processing logic that may comprise hardware (circuitry,dedicated logic, etc.), software (such as is run on a general-purposecomputer system or a dedicated machine), firmware, or a combination ofthe three.

In one embodiment, the command generator receives various inputs anddetermines the commands based on these inputs. In one embodiment, thecommand generator includes a recognizer, or recognition engine, thatperforms one or more recognition routines on the input data to generaterecognition results upon which it determines which of the commands thatthe user wants or is going to want to be performed. In one embodiment,the command generator uses a neural network (e.g., a deep learningneural network) as part of the process of determining the operations tobe performed by the ultrasound machine. One such embodiment is describedin more detail below.

In one embodiment, the generated operations include commands to controloperating parameters such as, for example, but not limited to, adjustinggain (e.g., increasing gain, decreasing gain) and adjusting depth (e.g.,increasing depth, decreasing depth). Other operating parameters such astransducer selection, turning on/off a mode (e.g., A-mode, B-mode or 2Dmode, B-flow, C-mode, M-mode, Doppler mode (e.g., Color Doppler,Continuous wave (CW) Doppler, Pulsed wave (PW) Doppler, Duplex, Triplex,etc.), Pulse inversion mode, Harmonic mode, etc.)., etc., could also begenerated.

In one embodiment, the operations include freezing an ultrasound imagebeing displayed by the ultrasound machine, saving an image beingdisplayed by the ultrasound machine, adding to and/or moving anannotation (e.g., a label) or pictogram on an image being displayed bythe ultrasound machine, and creating or filling in a report (e.g., abilling record, medical report, etc.) using information that is storedon or received by the ultrasound machine.

In one embodiment, the one or more touchless input comprises the resultsof lip reading recognition, captured audio information, imageinformation of an ultrasound image being displayed by the ultrasoundmachine, an examination type for the examination being performed by anindividual using the ultrasound machine, a list of operations (e.g., aworkflow) being performed by the user of the ultrasound machine, and/ora next action to be performed by the user of the ultrasound machine. Inone embodiment, one or more of such inputs are included in stateinformation fed back from an ultrasound control subsystem of theultrasound machine for use in command generation.

In one embodiment, the ultrasound system uses results of lip readingrecognition combined with speech data to improve the accuracy of thecontrol. In one embodiment, audio (e.g., a user's voice) is capturedwith a microphone and the captured audio is recognized for use incombination with the results of lip reading recognition in determiningan operating parameter to change or other operation that the user wantsperformed. In one embodiment, the audio is spoken by the user of theultrasound machine. Thus, in this manner, both audio and imagerecognition associated with a user mouthing a command are used todetermine the operating parameter to adjust or another operation thatthe user wants to perform.

In one embodiment, the selection of the inputs (e.g., touchless inputs)to use or the impact of all these inputs for command determinationchanges based on one or more factors. These factors may be environmentalfactors or other information obtained about the environment (e.g.,sensed from the environment). For example, in one embodiment, theoutputs from lip reading recognition and audio recognition are weightedsuch that each does not have the same impact or contribution on thedetermination of the operation being identified based on informationabout the environment. In one embodiment, based on the noise in theenvironment, the system determines the operation that the user wants toperform based more heavily on the results of lip reading operation thanthe results of the audio recognition, or vice versa. In one embodiment,this is accomplished by dynamically adjusting the weights on outputsfrom lip reading recognition and audio recognition. Therefore, if theenvironment is determined to be too noisy (e.g., the noise level isabove a threshold), then the results of the lip reading recognition maybe weighted higher than the results of the audio recognition (or evenexclusively used) when determining the operation that the user wants toperform.

In one embodiment, the ultrasound system ignores touchless inputs to theultrasound system until it undergoes activation mode when it isactivated to accept touchless inputs. Until the ultrasound systemundergoes activation mode, the ultrasound system determines the user islooking directly into the camera. In this case, the ultrasound systemignores any speech utterances unless the user was looking directly intothe camera when they were spoken. This would not present any reallimitation to the clinician since they are typically looking at themachine when they are making adjustments that are based on commands. Inanother embodiment, the activation mode of the ultrasound systemrequires a gesture such as, for example, a facial cue to begin listeningto speech utterances and/or studying visual data for lip reading.Examples of such a facial cue include, but are not limited to, closingboth eyes for a certain predetermined period of time (i.e., a longblink), winking, nodding, etc.

Note that other data such as examination type, worklist, system log-ininformation, or other state information that is stored and available inthe ultrasound machine may be used by the lip reading recognitionroutine to determine an operation that the user wants to perform.Similarly, image information associated with an image being displayed bythe ultrasound machine may also be used by the lip reading recognitionroutine to determine an operation that the user wants to perform.

After determining one or more operations based on the results of lipreading recognition and the machine state of the ultrasound machine, inone embodiment, processing logic generates and causes to be displayedone or more user selectable operations that can be performed by theultrasound machine (processing block 103). This starts a confirmationmode process that enables the user to select and/or confirm theoperation that the ultrasound machine is going to perform. This may beparticularly advantageous in situations where the command generatorcannot ascertain with certainty what operation the user wants performed.The uncertainty may be due to the lip reading recognition results beingless than 100% confident in its determination, due to some otherrecognition (e.g., audio recognition) results being less than 100%confident in its determination, and/or due to some other limitation inthe accuracy of the inputs used in the command generation process (e.g.,a mismatch between the command based on audio and the command based onthe lip reading, etc.).

In one embodiment, the selectable operations are presented on thedisplay and/or using audio (e.g., computer generated speech) of theultrasound machine under control of its ultrasound imaging subsystem. Inone embodiment, the selectable operations are presented in a listaccording to their likeliness (e.g., confidence) in matching the user'sdesired operation as determined by the command generator of theultrasound machine. In one embodiment, the list of selectable operationsincludes a confidence factor generated by the command generator for eachoperation or other information to provide the user with an indication ofthe level of confidence associated with the determination of theoperation by the ultrasound machine.

Note that presentation and/or confirmation operations are optional andnot required. In an alternative embodiment, a single operation isdetermined and the command generated for performance by the ultrasoundmachine without selection and/or confirmation.

Next, in one embodiment, processing logic controls the ultrasoundmachine using the operations generated based on lip reading and controlstate information (processing block 104). In another embodiment, theoperations are also generated based on audio information. In oneembodiment, the control is implemented in response to a selection and/orconfirmation of the operations, if necessary. In one embodiment, thecontrol is performed by a control subsystem of the ultrasound machine.

As set forth above, the determination of commands is based on performinglip reading and the recognition of lip movements. In one embodiment, thelip reading process is triggered in response to an activation mode,where the activation mode involves the occurrence of one or moreoperations. In one embodiment, one of the operations is a determinationthat the user is looking at the camera when speaking or lipping acommand to be performed by the ultrasound machine. In anotherembodiment, the lip movement recognition occurs in response to the userperforming a gesture that is recognized by the ultrasound machine. Inone embodiment, the gesture comprises performance of a facial cue. Inone embodiment, the facial cue comprises the eyes being closed by theuser for a predetermined period of time, winking by the user, nodding bythe user, or any other facial gesture. FIG. 2 is a flow diagram of oneembodiment of a process for triggering the lip reading performed above.In one embodiment, the process is performed by a recognizer orrecognition engine of a command generator of the ultrasound machine.

Referring to FIG. 2 , the process begins by determining a user fromwhich to receive touchless commands (processing block 201). In one ormore embodiments, this determination is made by at least one of thefollowing: determining a user is looking (e.g., directly looking) at acamera, determining the user performed a gesture, and through the use ofa user identification or authentication process.

Determining a user is looking (e.g., directly looking) at a camera ordetermining the user performed a gesture requires image data from acamera. Such a camera may be on or embedded in the system, located onthe probe of the ultrasound system, or attached to the ultrasoundsystem. In one embodiment, the ultrasound machine determines the user islooking at a camera using eye tracking. The eye tracking uses a camerato record movements of the eyes and processes those images to determinewhere the user is gazing in a manner well-known in the art. In oneembodiment, the camera used for performing eye tracking is a camera thatis also used to capture lip movements for the purposes of lip reading,though a separate camera may be used. In one embodiment, the eyetracking is augmented to enable the system to determine which individualin the examination area to track. In one embodiment, this augmentationincludes determining the orientation of face, facial recognition basedupon the person who started an examination, and/or accessing informationfrom a worklist that indicates a sonographer, physician, or otherhealthcare practitioner that is to be using the ultrasound machine forthe examination. Note that more than one user of the ultrasound machinefor the same examination may be identified in this manner.

In one embodiment, if an identified physician is a neonatologist, thesettings of the ultrasound system are optimized for visualizing smallanatomy as would be common in typical neonatal examinations. In oneembodiment, after the examination has started, the identity of thephysician is used as part of the machine learning process to moreaccurately predict the settings that the clinician or user may beseeking to adjust. Initial system settings are also determined using aprofile associated with a user login.

In one embodiment, the determination of whether the user performed agesture to trigger the lip reading recognition process is based on afacial cue or other wake gesture such as, for instance, but not limitedto, closing their eyes for a predetermined period of time (i.e., a longblink), winking, nodding, etc., performed by the user.

In response to either determining the user is looking at a camera ordetermining the user performed a gesture, processing logic performs lipreading (processing block 202) and the remainder of the commandgeneration process as described herein.

In an alternative embodiment, the system performs facial recognition orsome other user identification/authentication process on the individualand only responds to the commands from the face of the individual thatinitiated the examination. That is, the system identifies the individualfrom perhaps a group of individuals located in proximity to the system.This is done using a user identification operation (e.g., facialrecognition, obtaining ultrasound data such as a worklist or otherinformation identifying the individual that is giving the examination,etc.).

After determining a user is looking (e.g., directly looking) at acamera, determining the user performed a gesture, and through the use ofa user identification/authentication process, the system providescontrol of the ultrasound machine through use of touchless inputs to theidentified individual. In other words, the system allows that individualto provide control the system using their touchless inputs.

In one embodiment, once the ultrasound system determines theindividual(s) from which it will accept touchless commands for aparticular examination, the ultrasound system does not accept touchlesscommands from other individuals that may be present at the examination.

FIG. 3 is a block diagram of one embodiment of an ultrasound systemhaving a command generator as discussed above. In one embodiment, theultrasound machine includes a transducer probe to send and receive thesound waves (echoes) in a manner well-known in the art, which areprocessed to produce ultrasound images. The transducer probe has notbeen shown in FIG. 3 to avoid obscuring the techniques disclosed herein.

Referring to FIG. 3 , ultrasound control subsystem 332 includes one ormore processors. One processor causes electrical currents to be sent tothe transducer probe to emit sound waves and also receives theelectrical pulses from the probe that were created from the returningechoes. The processor processes the raw data associated with thereceived electrical pulses and forms an image. The processor sends theimage data to ultrasound imaging subsystem 332, which displays the imageon display 340. Thus, display screen 340 displays ultrasound images fromthe ultrasound data processed by the processor of ultrasound controlsubsystem 332.

The ultrasound system of FIG. 3 also includes one or more cameras 301 tocapture images or video information that is stored in memory 304. In analternative embodiment, microphone 302 records audio information that isalso stored in memory 304. In one embodiment, one or more othernon-audio inputs may be received by command generator 306. In oneembodiment, these other non-audio inputs comprise one or more offeedback of image information 310 from ultrasound imaging system 331 ofthe ultrasound machine and feedback of machine state 311 from ultrasoundcontrol subsystem 332 of the ultrasound machine. In one embodiment,other non-audio input data includes workflow information for a givenuser or for a given type of procedure or examination for use inpredicting or assisting in predicting next commands or steps in theexamination or procedure. These may also be stored in memory 304. Whilememory 304 is shown as a single block of storage in FIG. 3 , in analternative embodiment, the data from cameras 301, microphone 302 andthe non-audio inputs 303 are stored in more than one memory. In anadditional alternative embodiment, the data is streamed directly, via anetwork communication interface, to a processor in the cloud or localserver (e.g., cloud server 340) that is performing the operationsdescribed herein. In an alternative embodiment, the data is sentdirectly to a neural network (e.g., a deep learning neural network,etc.) for processing.

Command generator 306 accesses memory 304 and, in response thereto,generates one or more operations (e.g., commands) 320 for controllingthe ultrasound machine. In one embodiment, command generator 306 isintegrated into the ultrasound machine. In another embodiment, commandgenerator 306 is a stand-alone device that may be coupled, via wiredand/or wireless connection, to the ultrasound machine. In yet anotherembodiment, command generator 306 is part of a cloud-based computerresource that may be coupled, via wired and/or wireless connection, tothe ultrasound machine.

In one embodiment, command generator 306 includes one or moreprocessors, neural networks (e.g., a deep learning neural network,etc.), etc., to control the operation of ultrasound system throughgeneration of control options or operations.

In one embodiment, command generator 306 includes recognizer, orrecognition engine, 305 that performs recognition on the image data andaudio data captured by cameras 301 and microphone 302, respectively, aspart of generating the operations. For example, recognizer 305 accessesmemory 304 for captured image information from one or more cameras 301and performs lip reading recognition on lip movements captured bycameras 301 to determine a specific command from the individual that isusing the ultrasound machine. For instance, the user may have lipped thecommand to increase the gain on the image being displayed by ultrasoundimaging subsystem 331. The command is recognized by recognizer 305, and,in response thereto, command generator 306 accesses the current gainvalue that is provided in machine state information 311 and generates acommand to increase the gain of the ultrasound machine from its currentvalue to an increased value. In one embodiment, the gain increase is apreset amount. In another embodiment, the command provided by the userincludes an amount of parameter change that is desired “increase gain by10%”). In another embodiment, the gain increase that occurs whenperforming the command is specified by the user and is recognized byrecognizer 305. In yet another embodiment, due to network machinelearning image recognition features, an optimization delta is identifiedand the correct amount of gain is applied, such that the ultrasoundimage being displayed is optimized. After generating the command, thecommand is sent to ultrasound control subsystem 332 which controlsultrasound imaging subsystem 331 and causes the gain of the image beingdisplayed by ultrasound imaging subsystem 331 to be increased. In oneembodiment, the same process is performed to decrease the gain, increaseor decrease the depth, or control any other operating parameter.

In the case of freezing the image being displayed by the ultrasoundimaging subsystem 331, the lip movements specifying the command arerecognized by recognizer 305, and, in response thereto, commandgenerator 306 generates a command to ultrasound control subsystem 332 tosignal ultrasound imaging subsystem 331 to freeze the image beingdisplayed on display screen 340. Note that freezing an ultrasound imagemay be part of a process to save an ultrasound image.

In the case of saving the image being displayed by ultrasound imagingsubsystem 331, the lip movements specifying the command are recognizedby recognizer 305, and, in response thereto, command generator 306generates a command to ultrasound control subsystem 332 to signalultrasound imaging subsystem 331 to save the image being displayed ondisplay screen 340. Note that in one embodiment, the image data that isdisplayed by ultrasound imaging subsystem 331 is from ultrasound controlsubsystem 332. Therefore, in response to a command to ultrasound controlsubsystem 332 to save the image being displayed on display screen 340,ultrasound control subsystem 332 stores the image data for the imagebeing displayed on display screen 340 in a memory (e.g., memory 304).

In one embodiment, the command is recognized by recognizer 305, and, inresponse thereto, command generator 306 also accesses historical,workflow and/or examination data that is provided in machine stateinformation 311 and generates a command. For example, the user orphysician may have a habit of freezing or saving an image frame afteradjusting the depth of the image. Using the identity of the clinician oruser, as for example described above, an instruction or command can beautomatically implemented to save or freeze an image after a command wasgiven to change the depth of the image, thereby combining theoptimization delta with historical data. Historical data is not limitedto actions performed solely by one particular clinician (i.e., anindividual) and may be the actions of a group of individuals (e.g.,other clinicians, physicians, individuals at medical facilities, etc.).Furthermore, historical data can include previously used settings,parameters, and/or configurations of the system, data learned by thesystem or other systems (e.g., data from machine learning or artificialintelligence processes, etc.), etc.

In the case of an annotation, recognizer 305 recognizes the lipmovements as a command by the user to generate an annotation to beplaced on an image being displayed by ultrasound imaging subsystem 331.In one embodiment, the lip movements recognized by command generator 306not only include the command to add an annotation to the image beingdisplayed by imaging subsystem 331, but also include the actualannotation. Note that a combination of two or more touchless inputs(e.g., lip reading and speech) may be used together to increase theaccuracy of the dictation recognition. In one embodiment, the startingand ending of the annotation are also recognized by recognizer 305. Inone embodiment, recognizer 305 determines the starting and ending of theannotation by recognizing start and stop words being lipped by the user.In an alternative embodiment, the recognizer 305 recognizes one or moregestures (e.g., a facial cue) made by the user to indicate the start andstop of the annotation.

In one embodiment, recognizer 305 also recognizes commands lipped by theuser to move an annotation that is being displayed by the ultrasoundimaging subsystem 331 on the display. In one embodiment, recognizer 305recognizes lip movements indicating one or more commands to move theannotation up, down, left, and right on the image being displayed.

In one embodiment, recognizer 305 also recognizes lip movements togenerate a command to create a report. In one embodiment, the report maybe a billing record that is created and includes a predetermined set ofinformation that is necessary to ensure the bill is processed and paid.In another embodiment, the report includes a medical record report thatincludes the information from the ultrasound examination beingperformed. In one embodiment, the report creation includes dictatingnotes into the report. In one embodiment, the dictation of notes isperformed by having image of the report displayed on display screen 340by ultrasound image subsystem 331 and directing the ultrasound controlsubsystem to direct recognizer 305 recognizing lip movements, usingrecognizer 305, to indicate one or more commands to move the notes up,down, left, and right on the image being displayed to a specificlocation(s) in the report. Also, in one embodiment, recognizer 305determines the starting and ending of the dictated notes by recognizingstart and stop words being lipped by the user.

In one embodiment, command generator 306 generates operations 320 (e.g.,increase gain, decrease gain, increase depth, decrease depth, freezeimage, save image, etc.) in response to recognition results andinformation received from other portions of the ultrasound machine. Inone embodiment, the feedback includes feedback of machine stateinformation 301 from the ultrasound control subsystem 332. In anotherembodiment, the feedback includes feedback of image information 310 fromthe ultrasound imaging subsystem 331. The image information maycorrespond to the image being displayed on display screen 340. Thisinformation may be used to determine the operation that the user wantsto perform. For example, the ultrasound system may be able to determinea feature that the user is likely interested in viewing based on theworklist or examination type specified in control state information 311.Based on the appearance of that feature in the image, the ultrasoundsystem is able to use the information to bias the command that is beinggenerated based on results of the lip reading. That is, the results ofthe lip reading are impacted by an image feature or other imageinformation that is in the ultrasound system.

In one embodiment, the ultrasound system also has one or more user inputdevices (e.g., a keyboard, cursor control device, etc.) that inputs dataand allows the taking of measurements from the display of the ultrasounddisplay subsystem, a disk storage device (e.g., hard, floppy, compactdisks (CD), digital video discs (DVDs)) for storing the acquired images,and a printer that prints the image from the displayed data. These alsohave not been shown in FIG. 3 to avoid obscuring the techniquesdisclosed herein.

FIG. 4 illustrates a block diagram of one embodiment of recognizer 400.In one embodiment, recognizer 400 comprises processing logic havinghardware (circuitry, dedicated logic, etc.), software (such as is run ona general-purpose computer system or a dedicated machine), firmware, ora combination of the three.

Referring to FIG. 4 , recognizer 400 includes lip reading recognitioncomponent 401 that performs lip reading recognition in response to lipmovements captured by cameras in the ultrasound system.

In one embodiment, recognizer 400 includes audio recognition component402 that performs audio recognition on audio captured by microphone ofthe ultrasound system.

Optionally, in one embodiment, recognizer 400 includes eye trackingcomponent 403 that performs eye tracking. In one embodiment, the eyetracking component 403 determines that the user is looking directly atthe camera which triggers the lip reading recognition component 401 tooperate and perform recognition of lip movements captured by cameras ofthe ultrasound system.

In another embodiment, recognizer 400 includes gesture recognitioncomponent 404 that performs gesture recognition to trigger the operationof lip reading recognition component 401 and/or audio recognitioncomponent 402. In one embodiment, gesture recognition component 404recognizes one or more facial cues to trigger the operation of lipreading recognition component 401. In one embodiment, these facial cuescomprise the user closing their eyes for a predetermined period of time,the user winking, the user nodding, or any other predetermined facialmovement.

FIG. 5 is a block diagram of an embodiment of an ultrasound systemhaving a command generator that comprises artificial intelligence ormachine learning. Referring to FIG. 5 , only a subset of the componentsof the ultrasound system of FIG. 3 , such as cameras 301, microphone302, ultrasound imaging subsystem 331 and ultrasound control subsystem332, are shown to avoid obscuring command generator 501 that usesartificial intelligence or machine learning to generate commands. In oneembodiment, the artificial intelligence comprises a neural network, suchas, for example, but not limited to, a deep learning neural network.

In one embodiment, command generator 501 receives captured image datafrom cameras 301, optionally receives capture audio data 302, imageinformation 310 feedback from ultrasound imaging subsystem 331 andmachine state information 311 feedback from ultrasound control subsystem332 and uses the neural network to bias the determination of operationsor commands that correlate to the lip movements of the individual usingthe ultrasound machine.

In one embodiment, command generator 501 generates operations using adeep learning neural network or other neural network. Deep learning isone machine learning technique that employs representation learningmethods that allows a machine to be given raw data and determine therepresentations needed for data classification. Deep learning ascertainsstructure in data sets using backpropagation algorithms which are usedto alter internal parameters (e.g., node weights) of the deep learningmachine. Deep learning machines can utilize a variety of multilayerarchitectures and algorithms to process raw data to identify features ofinterest without external inputs specifying the features of interest.

Deep learning in a neural network environment includes numerousinterconnected nodes referred to as neurons. Upon activation, inputneurons activate other neurons based on connections to those otherneurons which are governed by the machine parameters. Learning refinesthese machine parameters as well as the connections between neurons inthe network, thereby causing the neural network to behave in a desiredmanner. In one embodiment, the deep learning network uses aconvolutional neural network (CNN) which processes data usingconvolutional filters to locate and identify learned, observablefeatures in the data. Each filter or layer of the CNN architecturetransforms the input data to increase the selectivity and invariance ofthe data. This abstraction of the data allows the network to focus onthe features in the data it is attempting to classify and ignoreirrelevant background information.

In one embodiment, the deep learning network uses convolutional neuralnetworks for image analysis as part of recognition for lip readingand/or medical image analysis to identify features of ultrasound images.In one embodiment, the CNN architecture is used for facial recognitionin natural images to identify the user of the ultrasound machine for thepurpose of eye tracking and determining whether the user is looking atthe ultrasound machine as discussed above. In one embodiment, the CNNarchitecture is also used for audio (e.g., speech) and video (e.g., lipreading) processing.

In one embodiment, the deep learning neural network includes multiplelayers which are connected with neural connections. Data flows forwardvia inputs from the input layer to an output layer and then to an outputof the deep learning neural network. The input layer, which includes aplurality of nodes, is followed by one or more hidden layers thatinclude nodes. After the hidden layer(s) is an output layer, whichincludes at least one node with an output. In one embodiment, each inputcorresponds to a node of the input layer, and each node of the inputlayer has a connection to each node of a hidden layer. Each node of onehidden layer has a connection to each node of the next hidden layer, andeach node last hidden layer has a connection to the output layer. Theoutput layer has an output to provide an output.

The CNN structure of the deep learning neural network feeds a structureto retain temporary information so that the feature informationidentified by the CNN architecture is processed as a sequence ofinformation. For example, the lip reading and audio information mayinclude a sequence of information that have different lengths and theinformation previously identified is used as context information for thecurrent information to enable identification of the user's commands. Inone embodiment, the structure includes one or more of a recurrent neuralnetwork (RNN), a Long Short-Term Memory (LSTM), and a gated recurrentunit (GRU).

In one embodiment, the nodes are fed with feature data obtained from thelip movements captured by the camera(s) of the ultrasound system.

Certain example connections may be given added weight while otherexample connections may be given less weight in the neural network.Input nodes are activated through receipt of input data via inputs.Nodes of hidden layers are activated through the forward flow of datathrough the network via the connections. A node of the output layer isactivated after data processed in hidden layers is sent via connections.When the output node of the output layer is activated, the output nodeoutputs an appropriate value based on processing accomplished in hiddenlayers of the neural network.

In one embodiment, the neural network comprises an image analysisconvolutional neural network (CNN), along with a RNN, LSTM, GRU or othersuch memory-based structure, for lip reading and/or determining one ormore features of an ultrasound image. The convolutional neural networkreceives an input image and generates image features in the form of avector. A network of LSTMs, RNNs, GRUs or other such structures receivesimage feature vector from the CNN and produce state and output vectorsthat are decoded into characters. The characters are used to determineif the lip movements in the images represent a command.

Thus, the use of artificial intelligence, in conjunction with a cameraon an ultrasound machine, allows the system to read the lips of the userto determine if the user is giving a command to the ultrasound machine.

In one embodiment, command generator 501 uses the deep learning neuralnetwork to generate and cause ultrasound image subsystem 331 to displayone or more selectable commands. The selectable commands have associatedconfidence indication information specifying a level of confidence thateach of the one or more commands is the command that is desired. In oneembodiment, the confidence indication information comprises a confidencelevel. Such confidence levels are generated using the neural network ina manner well-known in the art. The confidence levels are affected bythe dynamic weighting of different touch inputs used to generate thecommands.

In one embodiment, artificial intelligence is not merely determiningwhether the user is giving a command, but is also used in predictingcommands that the user is likely to give the system in the future. Thus,using machine state and image information 310 feedback from theultrasound imaging subsystem, the neural network of command generator501 determines operations or biases selection of commands that aregenerated.

For example, if a nerve in an ultrasound image is not centered in thedisplay screen and a clinician is inserting a needle close to the nerveto inject anesthesia, the neural network recognizes the needle in theimage and the examination type as specified in machine state information311 that is feedback from the ultrasound control system. Once the nerveis identified, the neural network determines or biases the commanddetermination to commands to change the depth and center the nerve inthe middle of the display screen, thereby providing ease-of-use in theanesthesiology area. That is, the lip reading command recognitioncorrelates what is displayed in the ultrasound image with what is beingrecognized through lip reading to bias the command generation processtoward commands that change the depth. In this way, knowledge of theworkflow is used to improve accuracy of lip reading.

FIG. 6 is a flow diagram of one embodiment of a process for controllingthe ultrasound machine using a neural network. In one embodiment, theprocess is performed by processing logic that includes a neural networkthat is implemented with processing logic that may comprise hardware(circuitry, dedicated logic, etc.), software (such as is run on ageneral-purpose computer system or a dedicated machine), firmware, or acombination of the three.

Referring to FIG. 6 , the process begins by performing lip reading,including capturing lip movements with one or more cameras andperforming recognition on the lip movements (processing block 601).

Processing logic also identifies one or more image characteristics in animage being displayed by the ultrasound imaging subsystem that is notoptimized (processing block 602) and correlates an operating parameterthat will change the image to help improve, and potentially optimize theimage characteristic(s) (processing block 603). This may occur prior toor simultaneously with the lip reading.

In response to performing lip reading and after correlating theoperating parameter that will change the image, processing logic uses aneural network (e.g., a deep learning neural network) to determineoperations to control the ultrasound machine (processing block 604). Theneural network determines the operations based on the results of lipreading recognition, machine state information of the ultrasound machineand based on the correlation of the operating parameter to change theimage. In one embodiment, the change of the image is an optimization,improvement, fix or other modification of the image. That is, in oneembodiment, the neural network correlates the operating parameter forthe optimization, improvement, fix or other modification of the image aspart of the process of determining the operation.

In one embodiment, after determining one or more operations based on theresults of lip reading recognition, the machine state information of theultrasound machine, and the correlation of the operating parameter tochange the image, processing logic displays one or more user selectableoperations that can be performed by the ultrasound machine (processingblock 605). Note that this is an optional step and is not required. Inan alternative embodiment, a single operation is determined and thecommand generated for performance by the ultrasound machine withoutselection or confirmation.

Displaying the operations that have been determined based on the inputsenables the user to select and/or confirm the operation(s) that theultrasound machine is going to perform, which is advantageous insituations where the command generator cannot ascertain with certaintywhat operation the user wants performed. This is a confirmation mode.

In one embodiment, the selectable operations are presented on thedisplay of the ultrasound machine under control of the ultrasoundimaging subsystem. In one embodiment, the selectable operations arepresented in a list according to their likeliness in matching the user'sdesired operation as determined by the command generator of theultrasound machine. In one embodiment, the list of selectable operationsincludes a confidence factor generated by the command generator for eachoperation or other information to provide the user with an indication ofthe level of confidence associated with the determination of theoperation by the ultrasound machine.

Next, processing logic controls the ultrasound machine using theoperations (processing block 606). In one embodiment, the control is inresponse to a selection and/or confirmation of the operations, ifnecessary. In one embodiment, the control is performed by the controlsubsystem of the ultrasound machine.

Note that operations other than those specified in FIG. 6 can bedetermined and used to control the ultrasound machine, such as those,for example, discussed above.

There is a number of example embodiments described herein.

Example 1 is a method for controlling operation of an ultrasoundmachine, the method comprising: obtaining one or more touchless inputs;determining one or more operations to control the ultrasound machinebased on the one or more touchless inputs and machine state of theultrasound machine; and controlling the ultrasound machine using atleast one of the one or more operations.

Example 2 is the method of example 1 that may optionally includeperforming lip reading, including capturing lip movements of anindividual using at least one camera, and wherein determining the one ormore operations to control the ultrasound machine is based on results ofperforming the lip reading

Example 3 is the method of example 1 that may optionally include thatdetermining the one or more operations is further based on ultrasounddata.

Example 4 is the method of example 1 that may optionally include thatultrasound data comprises one or more of ultrasound image data, anexamination type being performed with the ultrasound machine, and a listof operations being performed with the ultrasound machine.

Example 5 is the method of example 1 that may optionally include thatdetermining the one or more operations is further comprises predictingan operation that the individual is likely to perform based onhistorical data.

Example 6 is the method of example 1 that may optionally include thatdetermining the one or more operations is further based on capturedaudio information of the individual and comprises dynamically adjusting,based on an environment in which the ultrasound machine resides, weightsassociated with results of lip reading recognition and audio recognitionto determine the one or more operations to control the ultrasoundmachine.

Example 7 is the method of example 1 that may optionally include thatperforming lip reading is triggered in response to determining theindividual is looking directly at one camera of the one or more camerasor in response to determining the individual has closed at least one eyefor a predetermined period of time, winked, nodded, or performed anotherfacial cue or other gesture.

Example 8 is the method of example 1 that may optionally includeidentifying one or more image characteristics, and wherein determiningthe one or more operations is further based on a correlation of anoperating parameter to the one or more image characteristics and furtherwherein controlling the ultrasound machine using the at least one of theone or more operations comprises changing the operating parameter tochange an image.

Example 9 is the method of example 1 that may optionally includereceiving, at a neural network, one or more of feedback of ultrasounddata from an ultrasound imaging subsystem, feedback of machine statefrom an ultrasound control subsystem, at least one of the one or moretouchless inputs, and wherein determining the one or more operations tocontrol the ultrasound machine based on the one or more touchless inputsand the machine state of the ultrasound machine is performed by theneural network.

Example 10 is the method of example 1 that may optionally include thatdetermining one or more operations to control the ultrasound machinecomprises generating and displaying one or more selectable commands;capturing information from the individual; and interpreting the capturedinformation as confirming selection of at least one of the one or moreselectable commands prior to controlling the ultrasound machine usingthe at least one operation.

Example 11 is the method of example 1 that may optionally include thatthe one or more operations comprise at least one selected from a groupconsisting of adjusting gain, adjusting depth, freezing an image beingdisplayed by the ultrasound machine, saving an image being displayed bythe ultrasound machine, adding an annotation at a user-specifiedlocation on an image being displayed by the ultrasound machine, andcreating a report with one or more images displayed by the ultrasoundmachine.

Example 12 is the method of example 1 that may optionally include thatdetermining one or more operations to control the ultrasound machinecomprises placing an annotation on an image being displayed by theultrasound machine based on at least one of the one or more touchlessinputs.

Example 13 is the method of example 12 that may optionally include thatwherein determining one or more operations to control the ultrasoundmachine further comprises recognizing a start of annotation command, anend of annotation command and one or more annotation movement commandsbased on at least one touchless input.

Example 14 is the method of example 12 that may optionally include thatthe one or more annotation movement commands are recognized from eyetracking information.

Example 15 is the method of example 1 that may optionally includeidentifying the individual from a group of individuals located inproximity to the ultrasound machine based on user identificationoperation; and providing control of the ultrasound machine through useof touchless inputs to the identified individual.

Example 16 is an apparatus comprising: a display screen; an ultrasoundimaging subsystem coupled to the display to generate ultrasound imageson the display screen; an ultrasound control subsystem coupled tocontrol the imaging subsystem; one or more cameras to capture images oflip movements of an individual; a microphone to capture audio; arecognizer coupled to the one or more cameras to execute a liprecognition routine on captured images from the one or more cameras toperform lip reading; and a command generator coupled to the recognizerand the control subsystem to determine one or more operations based onone or more touchless inputs from the recognizer and microphone andmachine state of the ultrasound machine received from the ultrasoundcontrol subsystem and send at least one of the one or more operations tocontrol the ultrasound control subsystem.

Example 17 is the apparatus of example 16 that may optionally includethat the command generator comprises a neural network.

Example 18 is the apparatus of example 16 that may optionally includethat the command generator is operable to determine the one or moreoperations based further on ultrasound data.

Example 19 is the apparatus of example 18 that may optionally includethat the ultrasound data comprises one or more of ultrasound image data,an examination type being performed with the ultrasound machine, and alist of operations being performed by the ultrasound machine.

Example 20 is the apparatus of example 16 that may optionally includethat the command generator is operable to determine the one or moreoperations by predicting an operation that the individual is likely toperform based on historical data.

Example 21 is the apparatus of example 16 that may optionally includethat the command generator is operable to determine the one or moreoperations based further on captured audio information of the individualand to dynamically adjust, based on an environment in which theultrasound machine resides, weights associated with results of lipreading recognition and audio recognition to determine the one or moreoperations to control the ultrasound machine.

Example 22 is the apparatus of example 16 that may optionally includethat the recognizer is operable to trigger touchless input control foruse by the individual in response to a determination that the individualis looking at one camera of the one or more cameras or in response to afacial cue, wherein the facial cue comprises one of a group consistingof: closing at least one eye for a predetermined period of time,winking, nodding.

Example 23 is the apparatus of example 16 that may optionally includethat the command generator comprises a neural network that is operableto receive feedback of ultrasound data from the ultrasound imagingsubsystem, feedback of machine state from the ultrasound controlsubsystem, and at least one of the one or more touchless inputs of theindividual from the recognizer, and, in response thereto, the commandgenerator is operable to determine the one or more operations to controlthe ultrasound control subsystem.

Example 24 is the apparatus of example 16 that may optionally includethat the one or more operations comprise at least one selected from agroup consisting of adjusting gain, adjusting depth, freezing an imagebeing displayed by the ultrasound machine, saving an image beingdisplayed by the ultrasound imaging subsystem, adding an annotation at auser-specified location on an image being displayed by the ultrasoundimaging subsystem, and creating a report with one or more imagesdisplayed by the ultrasound imaging subsystem.

Example 25 is the apparatus of example 16 that may optionally includethat the one or more operations comprise placing an annotation on animage being displayed by the ultrasound imaging subsystem based on theone or more touchless inputs, including recognizing a start ofannotation command, an end of annotation command and one or moreannotation movement commands based on information captured from theindividual.

Example 26 is an article of manufacture having one or more computerreadable storage media storing instructions thereon which, when executedby a system, cause the system to perform a method for controllingoperation of an ultrasound machine, where the method comprises:obtaining one or more touchless inputs; determining one or moreoperations to control the ultrasound machine based on the one or moretouchless inputs and machine state of the ultrasound machine; andcontrolling the ultrasound machine using at least one of the one or moreoperations.

Some portions of the detailed descriptions above are presented in termsof algorithms and symbolic representations of operations on data bitswithin a computer memory. These algorithmic descriptions andrepresentations are the means used by those skilled in the dataprocessing arts to most effectively convey the substance of their workto others skilled in the art. An algorithm is here, and generally,conceived to be a self-consistent sequence of steps leading to a desiredresult. The steps are those requiring physical manipulations of physicalquantities. Usually, though not necessarily, these quantities take theform of electrical or magnetic signals capable of being stored,transferred, combined, compared, and otherwise manipulated. It hasproven convenient at times, principally for reasons of common usage, torefer to these signals as bits, values, elements, symbols, characters,terms, numbers, or the like.

It should be borne in mind, however, that all of these and similar termsare to be associated with the appropriate physical quantities and aremerely convenient labels applied to these quantities. Unlessspecifically stated otherwise as apparent from the following discussion,it is appreciated that throughout the description, discussions utilizingterms such as “processing” or “computing” or “calculating” or“determining” or “displaying” or the like, refer to the action andprocesses of a computer system, or similar electronic computing device,that manipulates and transforms data represented as physical(electronic) quantities within the computer system's registers andmemories into other data similarly represented as physical quantitieswithin the computer system memories or registers or other suchinformation storage, transmission or display devices.

The present invention also relates to apparatus for performing theoperations herein. This apparatus may be specially constructed for therequired purposes, or it may comprise a general-purpose computerselectively activated or reconfigured by a computer program stored inthe computer. Such a computer program may be stored in a computerreadable storage medium, such as, but is not limited to, any type ofdisk including floppy disks, optical disks, CD-ROMs, andmagnetic-optical disks, read-only memories (ROMs), random accessmemories (RAMs), EPROMs, EEPROMs, magnetic or optical cards, or any typeof media suitable for storing electronic instructions, and each coupledto a computer system bus.

The algorithms and displays presented herein are not inherently relatedto any particular computer or other apparatus. Various general-purposesystems may be used with programs in accordance with the teachingsherein, or it may prove convenient to construct more specializedapparatus to perform the required method steps. The required structurefor a variety of these systems will appear from the description below.In addition, the present invention is not described with reference toany particular programming language. It will be appreciated that avariety of programming languages may be used to implement the teachingsof the invention as described herein.

A machine-readable medium includes any mechanism for storing ortransmitting information in a form readable by a machine (e.g., acomputer). For example, a machine-readable medium includes read onlymemory (“ROM”); random access memory (“RAM”); magnetic disk storagemedia; optical storage media; flash memory devices; etc.

Whereas many alterations and modifications of the present invention willno doubt become apparent to a person of ordinary skill in the art afterhaving read the foregoing description, it is to be understood that anyparticular embodiment shown and described by way of illustration is inno way intended to be considered limiting. Therefore, references todetails of various embodiments are not intended to limit the scope ofthe claims which in themselves recite only those features regarded asessential to the invention.

We claim:
 1. A method for controlling an ultrasound machine, the methodcomprising: receiving one or more touchless inputs; determining amachine state of the ultrasound machine; and determining, using a neuralnetwork, one or more operations for controlling the ultrasound machinebased on the one or more touchless inputs, the machine state, andcaptured audio information, wherein the one or more touchless inputs andthe captured audio information are weighted to change a contribution ofeach of the one or more touchless inputs and the captured audioinformation to determine the one or more operations to control theultrasound machine based on an environment in which the ultrasoundmachine resides.
 2. The method of claim 1 wherein the captured audioinformation is of an individual using the ultrasound machine.
 3. Themethod of claim 1 further comprising controlling the ultrasound machineusing at least one of the one or more operations, including changing anoperating parameter to change an image.
 4. The method of claim 1 whereinthe machine state comprises ultrasound data.
 5. The method defined inclaim 4 wherein the ultrasound data comprises one or more of ultrasoundimage data, an examination type being performed with the ultrasoundmachine, and a list of operations being performed with the ultrasoundmachine.
 6. The apparatus defined in claim 5 wherein the one or moreoperations comprise at least one selected from a group consisting ofadjusting gain, adjusting depth, freezing an image being displayed bythe ultrasound machine, saving an image being displayed by theultrasound imaging subsystem, adding an annotation at a user-specifiedlocation on an image being displayed by the ultrasound imagingsubsystem, and creating a report with one or more images displayed bythe ultrasound imaging subsystem.
 7. The method of claim 1 furthercomprising: performing lip reading, including capturing lip movements ofan individual using at least one camera, and wherein determining the oneor more operations to control the ultrasound machine is based on resultsof performing the lip reading.
 8. The method of claim 1 whereindetermining the one or more operations comprises predicting an operationthat the individual is likely to perform based on historical data. 9.The method of claim 1 further comprising identifying one or more imagecharacteristics, and wherein determining the one or more operations isfurther based on a correlation of an operating parameter to the one ormore image characteristics.
 10. A system for controlling an ultrasoundmachine, the system comprising: one or more sensors to receive at leastone touchless input; and an ultrasound control subsystem to generatemachine state information of the ultrasound machine, identify anindividual from a group of individuals located in proximity to theultrasound machine based on user identification operation; and providecontrol of the ultrasound machine through use of touchless inputsattributed to the identified individual, wherein the ultrasound controlsystem comprises a command generator to determine, using a neuralnetwork, one or more operations to control the ultrasound machine basedon the at least one touchless input and the machine state information,wherein the at least one touchless input and the captured audioinformation are weighted to change a contribution of each of the atleast one touchless input and the captured audio information todetermine the one or more operations to control the ultrasound machinebased on an environment in which the ultrasound machine resides.
 11. Thesystem of claim 10 wherein the command generator comprises the neuralnetwork.
 12. The apparatus defined in claim 10 wherein the commandgenerator is operable to determine the one or more operations bypredicting an operation that the individual is likely to perform basedon historical data.
 13. The system of claim 10 wherein the commandgenerator is operable to determine the one or more operations basedfurther on captured audio information of the individual.
 14. The systemof claim 10 wherein the machine state comprises ultrasound data.
 15. Thesystem of claim 14 wherein ultrasound data comprises one or more ofultrasound image data, an examination type being performed with theultrasound machine, and a list of operations being performed with theultrasound machine.
 16. The apparatus defined in claim 10 wherein theone or more operations comprise at least one selected from a groupconsisting of adjusting gain, adjusting depth, freezing an image beingdisplayed by the ultrasound machine, saving an image being displayed bythe ultrasound imaging subsystem, adding an annotation at auser-specified location on an image being displayed by the ultrasoundimaging subsystem, and creating a report with one or more imagesdisplayed by the ultrasound imaging subsystem.
 17. An article ofmanufacture having one or more computer readable storage media storinginstructions thereon which, when executed by a system, cause the systemto perform a method for controlling operation of an ultrasound machine,the method comprising: receiving one or more touchless inputs;determining a machine state of the ultrasound machine; and determining,using a neural network, one or more operations for controlling theultrasound machine, based on the one or more touchless inputs, themachine state, and captured audio information, wherein the one or moretouchless inputs and the captured audio information are weighted tochange a contribution of each of the one or more touchless inputs andthe captured audio information to determine the one or more operationsto control the ultrasound machine based on an environment in which theultrasound machine resides.
 18. The article of manufacture of claim 17wherein the captured audio information is of an individual using theultrasound machine.